On 6th February 2023, an earthquake measuring 7.8 on the Richter scale devastated southern Turkey and northern Syria. Significant aftershocks and subsequent earthquakes also continue to contribute to the devastation experienced by civilians in this region. The official death toll is over 53,000 (as of 4th March 2023) across both countries and has been estimated to have affected 8.8 million people in Syria. In Syria, the most affected area by the earthquake is northwest Syria with 7,259 deaths3 and 12,000 injuries (estimates range from 8,700-14,000) in Idlib and Aleppo governorates though these figures are set to rise.

This region includes the non-government-controlled territory in northwest Syria, an area which currently encompasses Idlib governorate and parts of Aleppo governorate where around 4.5 million reside. More than 65% of the population are internally displaced people (IDPs), and most IDPs are women and children in an extremely vulnerable humanitarian position even before the earthquake6 with nearly 4.1 million in this area dependent on humanitarian aid to meet basic needs. Highly vulnerable groups include those who were already internally displaced throughout northwest Syria, as well as women, children, people with disabilities, and the elderly, which comprise the majority of the population. In this area, 1.4 million lived in tented settlements and already faced freezing temperatures over the harsh winter even prior to this disaster. At the time of the earthquakes, access to this area was essentially limited to cross-border aid via Bab al Hawa border crossing (and subject to UNSC resolutions every six months) with negligible cross-line (from areas under government control) aid.

According to the UN, more than 10,000 buildings, including at least 55 health facilities, have been completely or partially destroyed in northwest Syria, with at least 4 hospitals evacuated including 2 maternity hospitals11. This has placed an additional burden on existing health facilities which provide critical services to civilians across northwest Syria. Infrastructure needs such as water, fuel, and electricity were already scarce ahead of the impacts of the earthquake. As a result, the risk of communicable diseases outbreaks (including vaccine preventable diseases) is high with a likely surge in cases of cholera, an outbreak of which is ongoing since September 202212. As of 28th February 2023, more than 50,000 suspected cholera cases have been declared in the ongoing outbreak in northwest Syria13. Other parts of Syria including those under government control (accounting for two thirds of the country) and northeast Syria have also felt shocks with some degree of destruction.

In this document, we highlight key, early challenges to the humanitarian response in northwest Syria, how these have contributed to preventable rising mortality and morbidity together with recommendations in light of the earthquakes.